The Position And Volume Changes Of The Buccal Fat Pad After L-shaped Reduction Malarplasty

Background:Because of the different aesthetics standards between the East and the West,the western people are keen to owing abnormal protrusion malar surface,while the eastern people are on the opposite,and the abnormal protrusioned zygomatic bone are considered unattractive.More and more people are choosing to reshape facial contours through plastic surgery operation.The L-shaped reduction malarplasty combined with the small incision in front of the ear is a widely used procedure,which can effectively constrict the width of the middle part of the face,and metain zygomatic height at 45 degrees at the sametime.During clinical work,we found that the reduction of zygomatic bone complex exerted a compression effect on the buccal fat pad,which caused the changes of the buccal fat pad s position and form.Most commonly,patients present with a small,round "marble"-size contour irregularity in the cheek.lt was observed that the removal of the portion of the buccal fat pad significantly improved the cheek contour.Anatomically,the buccal fat pad is closely related to the zygomatic bone.In this paper,the three-dimensional CT reconstruction of the skull and two-dimensional computed tomography images were used to measure and analyze the position and volume changes of the buccal fat pad after the L-shaped malarplasty.Explore and study the effect of the L-shaped reduction malarplasty combined with the resection of the buccal fat pad on the buccal contour shape.Materiais and Methods:1.Successive cases of 22 patients with not undergone any cosmetic and craniofacial plastic surgery treated at the Department of Maxillofacial Plastic Surgery,Plastic Surgery Hospital,Chinese Academy of Medical Sciences from January 2016 to September 2018.The patient s skull CT scan data was used to reconstruct the buccal fat pad in the mimics software to establish a three-dimensional coordinate system.The buccal process with shallow position and the greatest influence on the appearance of soft tissue of the cheek was selected,and the maximum transverse diameter,cross-sectional area and volume were measured.Futher,the morphological characteristics of the buccal process woud be discussed.2.A retrospective study of 12 patients who underwent L-shaped reduction malarplasty at the Department of Maxillofacial Plastic Surgery,Department of Plastic Surgery,Chinese Academy of Medical Sciences,from January 2016 to September 2018.The patient did not undergo any other facial contouring or cosmetic surgery during the malarplastic surgery until the review.A three-dimensional reconstruction of the buccal fat pad with mimics software to establish a coordinate system.The volume of the buccal fat pad before and after surgery was measured.Compare the changes and analyzed the reason.3.Cases of 15 patients with not undergone any cosmetic and craniofacial plastic surgery treated at the Department of Maxillofacial Plastic Surgery,Plastic Surgery Hospital,Chinese Academy of Medical Sciences from January 2016 to September 2018.To summarize and analyze the treatment of patients with partial L-shaped osteotomy and partial discectomy,and to evaluate the effect of lowering the tibial osteotomy and removing the buccal fat pad on the cheek contour.Results:A three-dimensional reconstruction model of the buccal fat pad was established,and the buccal fat pad of 22 patients(44 sides)was analyzed to investigate the basic morphological features of the buccal process.The buccal process of the buccal fat pad is superficial located and has the greatest influence on the shape of the cheek.The volume of the buccal process has symmetry,the average volume is(1390±397.6)mm3,which is not significantly different from female and male.The average volume of the posterior zygomatic fat pad was(2841.8±859.0)mm3 before the reduction malarplasty.The average postoperative volume was(1831.8±595.1)mm3.The average volume of the posterior zygomatic fat pad and the preoperative phase.The ratio was significantly reduced(P<0.05)and reduced by about 35%.The average volume of buccal process was(1388.6±340.6)mm3 before surgery,and the postoperative time was(2470.5±551.7)mm3.The volume was significantly larger than that before surgery(P<0.05),which was increased by 44%.The volume of the posterior zygomatic pad was reduced by an average of(1010.1±412.8)mm3,and the volume of the buccal process was increased by an average of(1082.0±337.0)mm3,P=0.539,indicating a decrease in the volume of the posterior zygomatic pad and an increase in the volume of the buccal process.The difference was not statistically significant.Conclusion:1.The boundary between the buccal fat pad and its surrounding tissue can be discerned on the CT slice.The buccal process is the most influential part of the cheek shape.CT showed that the upper edge of the buccal process was the parotid duct,and the posterior lateral margin was the ascending branch of the mandible and the front of the masseter muscle.The medial and buccal muscles were adjacent to each other.The anterior lateral border was the fascia layer surrounding the venous canal.The maximum transverse diameter and cross-sectional area of the buccal fat pad buccal process from the tibia through the parotid duct to the anterior space of the masseter muscle increased first and then decreased.The buccal volume has symmetry,and the average volume(1390±397.6)mm3,about 1.4 ml,is not significantly different for men and women.2.The reduction of the zygomatic bone complex reduces the space inside the zygomatic arch,and squeezes the buccal fat pad located on the deep side to redistribute its volume.The volume of posterior zygomatic pad is reduced and the buccal protrusion is significantly increased.The volume changes in buccal fat pad provides an idea for the improvement of subsequent soft tissue contours,providing guidance for quantifying the removal of the buccal fat pad.3.The L-shaped reduction malarplasty combined removal of the buccal fat pad can obtain satisfactory results.